OIG Data Brief Documents Excessive Medicare Part D Opioid Prescriptions


The U.S. Department of Health & Human Services Office of Inspector General (OIG) released a data brief that summarizes data on opioid prescriptions for Medicare Part D enrollees. The data illustrates that in 2016, a third of beneficiaries received a prescription for opioids and one-tenth of all enrollees received opioids on a regular basis. Eighty percent of the prescriptions were for Schedule II or III controlled substances, the highest potential for abuse. Many of these beneficiaries were prescribed for over two and a half times the recommended dosage by the Centers for Disease Control.

The OIG concluded that the data raised concerns that (1) beneficiaries are receiving medically unnecessary drugs; (2) opioids could be diverted for resale; (3) beneficiaries’ identification numbers may be stolen; and (4) beneficiaries are doctor shopping (receiving high dosages from four or more prescribers and four or more pharmacies). These issues contribute to the risk of overuse, overdose, and the ongoing opioid epidemic.

The report warns that prescribers who are outliers in the data for prescribing opioids are prime targets for investigation. In the study, 401 prescribers’ (one-third of which were nurse practitioners or physician assistants) prescription patterns were found to warrant scrutiny and, in fact, the OIG announced fraud charges against these providers on July 13, 2017.

All providers should carefully consider their prescribing patterns for opioids to avoid OIG scrutiny. It is recommended that providers ensure medical necessity and check the New Jersey Prescription Monitoring Program. Moreover, providers are reminded to adhere to the new requirements issued by the New Jersey Board of Medical Examiners concerning initial prescriptions for acute pain.

Related Practices:   Healthcare Law

Related Attorney:   Joseph M. Gorrell, Keith J. Roberts